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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:287-293 • 0278-4297

Case Series

Diagnosis of Pregnancy-Associated Uterine Venous Plexus Thrombosis on the Basis of Transvaginal Sonography

Zvi Leibovitz, MD, Simon Degani, MD, Israel Shapiro, MD, Joseph Tal, MD, Baram Paz, MD, Zohar Levitan, MD, Ariel Aharoni, MD, Aurora Toubi, MD, Lilliana Schliamser, MD, Elisha Bar-Meir, MD and Gonen Ohel, MD

Departments of Obstetrics and Gynecology (Z.L., S.D., I.S., J.T., B.P., Z.L., A.A., G.O.), Radiology (A.T., E.B.), and Hematology (L.S.), Bnai Zion Medical Center, Haifa, Israel.

Address correspondence and reprint requests to Zvi Leibovitz, MD, Department of Obstetrics and Gynecology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel.

Objective. To describe the sonographic signs of uterine venous plexus thrombosis. Methods. Four pregnant patients had a diagnosis of uterine venous plexus thrombosis in the first half of gestation. The diagnosis was based on transvaginal sonography only in 3 cases, and the fourth had magnetic resonance imaging corroboration. Results. All 4 patients had similar sonographic features of uterine venous plexus thrombosis on transvaginal sonographic examination. The thrombi within the dilated veins were shown as elongated echogenic structures along the lumen that appeared round on transverse views of the affected veins. They showed swinging movements provoked by gentle transducer pressure. Power and color Doppler sonography enhanced the uterine venous plexus thrombosis diagnosis by showing blood flow around the thrombi. There were no signs of thromboembolic disease. Sonographic findings in deep leg veins and iliac veins were normal in all cases. Complete thrombophilia studies did not reveal any abnormalities. The uterine venous plexus thrombosis could not be detected on transabdominal sonography and was shown better by transvaginal sonography compared with magnetic resonance imaging. During 3 months of anticoagulation therapy, the thrombi gradually disappeared in all cases. Conclusions. Focusing on the pelvic veins while performing a transvaginal sonographic study during pregnancy may reveal important findings, which may have clinical implications. The therapeutic treatment of uterine venous plexus thrombosis is controversial and still empirical.

Key Words: thrombosis • transvaginal sonography • uterine venous plexus

Abbreviations: CT, computed tomography • MRI, magnetic resonance imaging • TVS, transvaginal sonography • UVPT, uterine venous plexus thrombosis

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Copyright © 2003 by the American Institute of Ultrasound in Medicine.